District Benefits: Classified Employees
Health Plan Election Form:
2026-2027 Classified Couples Rate Health Plan Election Form: Both spouses or Domestic Partners must be on SISC Composite rates to qualify
SISC Forms:
- SISC Membership Change Form
- SISC III Enrollment Enrollment Form
- SISC Kaiser Enrollment Form
- SISC Digital Signature Instructions
- SISC WABE Employee Election Form
WABE is Waiver of Active Benefits Enrollment, now includes Dental and Vision - SISC HIPPA Notice of Privacy
- SISC Cobra Notice
- Notice: Medical Insurance Benefits provided to Domestic Partners as Taxable Income
Classified SISC Health Matrix:
- The 2026-2027 Classified Health Matrix is page two of the HPEF located here
Classified Benefit Plans:
- Anthem Blue Cross Enrollment Guide
- Blue Cross PPO: 40011A - 100-A $20 Rx 7-25 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011B - 100-B $20 Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011C - 90-A $20 Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011E - 80-G $30 Rx 9-35 | Summary | SBC | Plan Document
- HSA $5,000 Two-Tier: 70111B - 70%, $5k/$10k Deductible, Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross Diamond: M215 - Primary Care Plan Rx 9-35 | Summary | SBC | Plan Document
- Kaiser Enrollment Guide
- Kaiser HMO: 244380-0027 - 100% OV $10 Rx 10 | Summary | SBC | Plan Document
- Kaiser HMO: 244380-0028 - 100% OV $20 Rx 10-20 | Summary | SBC | Plan Document
- Navitus Plan Information
- Delta Dental: 7079 1290 - DD 2000; A 100/1500 | Summary
- VSP: 2523/64253ALN - Signature C $0; 2nd pair glasses | Summary
- Mutual Of Omaha Group Life Insurance: G000AMP6-A002: Term Life plus AD&D
Contact Numbers
SISC Customer Service Contacts